1AC
Contention One: Inherency

HEALTH WORKERS ARE LEAVING SUB-SAHARAN AFRICA AT AN ALARMING RATE.
The Guardian Unlimited, 7/19/07, “Brain Drain still Hurting World’s Poorest Countries,” http://business.guardian.co.uk/economy/story/0,,2130482,00.html
Seeking health care in Ethiopia can be a difficult task. For every hundred thousand people, only two doctors are available as many of the country's physicians flock to the west.
Many of the world's least developed countries are losing large parts of their already shallow pool of skilled professionals to western countries - hindering their ability to pull themselves out of poverty, a report by the UN said today.
The UN's development arm warned that countries such as Ethiopia could see their long-term growth prospects damaged if the "brain drain" is not addressed
The study by the United Nations Conference on Trade and Development added that foreign aid has been largely ineffective because it has failed to recognise the importance of knowledge and innovation in driving development.
"The problem of brain drain highlights the bigger issue of knowledge," said Charles Gore, one of the report's authors. "We need to adopt new policies which should be orientated to reducing the technology gap and diversifying the economy.
"The least developed countries have a huge problem when it comes to expanding their productive employment. It is no use just investing in human capital without policies which develop employment opportunities to encourage workers to stay."
The report showed that in 2004, 1 million educated people from LDCs emigrated out of a total skilled pool of 6.6 million - a loss of 15%. Haiti, Samoa, Gambia and Somalia were among the LDCs who have lost more than half of their university-educated professionals in recent years.
The health sector, in particular, has suffered from a large loss of trained workers, which UNCTAD said often had a severe impact on the standard of service available to the poor.
In Bangladesh, 65% of all newly graduated doctors seek jobs abroad and the country loses 200 doctors from the government sector each year.
The problem is heightened by many developed countries such as the US and UK actively gearing their employment policies to welcome more migrant workers in an attempt to make up for labour shortages.
The Organisation for Economic Co-operation and Development recently reported that in 2005, between a quarter to a third of all practising doctors in countries such as the UK, US, Canada and Australia were trained in another country. While sub-Saharan Africa on average has only 13 doctors for 100,000 people, the US level is close to 300, UNCTAD said.
Africa, in particular, suffers from large outflows of labour due to political conflict, unstable economic conditions and low wages. Without this workforce, innovation, technological change and, in turn, progress in overcoming the factors that drive away skilled labour are limited, UNCTAD said.
1AC

STATUS QUO EFFORTS FAIL TO EFFECTIVELY GRAPPLE WITH THE NATURE OF THE HEALTH CARE AND DISEASE CRISIS
Laurie Garrett, Senior Fellow For Global Health who appeared before Senate Subcommittee, Jan/Feb 2007, pg 14 vol 86 #1

Less than a decade ago, the biggest problem in global health seemed to be the lack of resources available to combat the multiple scourges ravaging the world's poor and sick. Today, thanks to a recent extraordinary and unprecedented rise in public and private giving, more money is being directed toward pressing heath challenges than ever before. But because the efforts this money is paying for are largely uncoordinated and directed mostly at specific high-profile diseases -- rather than at public health in general -- there is a grave danger that the current age of generosity could not only fall short of expectations but actually make things worse on the ground.

This danger exists despite the fact that today, for the first time in history, the world is poised to spend enormous resources to conquer the diseases of the poor. Tackling the developing world's diseases has become a key feature of many nations' foreign policies over the last five years, for a variety of reasons. Some see stopping the spread of HIV, tuberculosis (TB), malaria, avian influenza, and other major killers as a moral duty. Some see it as a form of public diplomacy. And some see it as an investment in self-protection, given that microbes know no borders. Governments have been joined by a long list of private donors, topped by Bill and Melinda Gates and Warren Buffett, whose contributions to today's war on disease are mind-boggling.

Thanks to their efforts, there are now billions of dollars being made available for health spending -- and thousands of nongovernmental organizations (NGOs) and humanitarian groups vying to spend it. But much more than money is required. It takes states, health-care systems, and at least passable local infrastructure to improve public health in the developing world. And because decades of neglect there have rendered local hospitals, clinics, laboratories, medical schools, and health talent dangerously deficient, much of the cash now flooding the field is leaking away without result.


Plan: The USFG should provide necessary incentives to establish 1 million jobs in Sub-Saharan Africa for public health workers.

Advantage One: Disease

THE LOSS OF ONE OR TWO SPECIALISTS CRUSHES EFFECTIVENESS OF HEALTH CARE SYSTEM
Tim Martineau, Sr Lecturer in Human Res. Mgmt Int’l Health Research Group, Karola Decker, Lec poli sci / IR U Hamburg, and Peter Bundred, Sr lecturer Dept of Primary Care, U Liverpool, October 2004, Health Policy , Volume 70, Issue 1, “‘Brain drain’ of health professionals: from rhetoric to responsible action” p. 3-4

Of all the professionals lost to source countries the most frequently reported on are health professionals, along with the impact of consequent under-staffing of health systems. The measurement of these losses is problematic. We know of no personnel systems that record “migration” as a reason for resignation; a person might have moved to the private health sector, or have taken up a different career. When some individuals migrate they take long leave in case they need to return to their old job. Consequently this would not be recorded as a loss. However, there was plenty of anecdotal evidence used to attribute vacancies to migration (Ghanaian and South African informants, 2000). Sometimes the numbers are quite striking: 114 (60%) of the 190 registered nurses left a tertiary hospital in Malawi between 1999 and 2001 [18]. Exact reasons for leaving are not recorded in Malawi, but given the losses to migration reported by other institutions in that country it can be safely assumed that a significant proportion will have migrated. The impact of the loss of one or two staff with specialist skills may be just as significant as the loss of more general staff in greater numbers. The Centre for Spinal Injuries in Boxburg, near Johannesburg, South Africa was the referral centre for the whole region. On the same day in 2000 the two anaesthetists were recruited by a Canadian institution opening a new Spinal Injuries Unit. A consequence of the loss of these two key staff was the temporary closure of the Centre (South African informant, 2000).


AFRICAN HEALTH WORKER SHORTAGES INCREASE PREVENTABLE DISEASE CASES AND CRIPPLE THE SYSTEM
Health Global Access Project, Advocacy group of health experts dedicated to achieving equitable access to treatment for all AIDS patients, 8-05, http://www.healthgap.org/hgap/accomplish.html

Health workers – nurses, doctors, pharmacists, community health workers, laboratory technicians, physician assistants, and many more – are at the core of health systems everywhere. Where there are health worker shortcomings, health systems will suffer, resulting in preventable death and disease. Where health workforces are in crisis, health systems will be in crisis. Such is the case in many countries in sub-Saharan Africa.

The Scope of the Crisis
In Africa, a mere 1.3% of the world’s health workers struggle against all odds to combat fully 25% of the global disease burden.1 An eminent group of more than 100 global health experts estimate Africa’s shortage of health workers at 1 million; other estimates find the shortage to be even greater.2 While the numbers and types of health workers will vary by country, these statistical snapshots leave no doubt as to the scope of the crisis.


TENS OF THOUSANDS OF AFRICANS DIE A DAY FROM PREVENTABLE DISEASE. DOUBLING HEALTH WORKERS IS KEY TO ENSURE QUALITY MEDICAL CARE
American Jewish World Service, News Periodical, 2007, “Take action to fight preventable disease in sub-saharan Africa,” http://action.ajws.org/campaign/HealthCareWorkers

Every day, tens of thousands of people die from preventable disease in sub-Saharan Africa. The impact and rapid spread of diseases like AIDS, malaria and TB have overwhelmed the small number of medical professionals working in the region. Sub-Saharan Africa needs to at least double its current number of doctors, nurses and other healthcare workers to ensure that everyone has access to quality medical care. Help the people of Africa by urging your Senators to co-sponsor the African Health Capacity Investment Act. This bill proposes allocating financial resources to train, build and retain a strong African healthcare workforce. This is a vital step in making improved access to healthcare a reality. Please act now!



HUNDREDS OF MILLIONS WILL DIE IN THE COMING YEARS OF TREATABLE DISEASE AND THE NUMBERS ARE ONLY INCREASING
Rotimi Sankore, Medical Activist and freelance Writer, December 10, 2006, “Right to Health Most Important Right of All”
The horrendous figures that demand urgent action speak for themselves. An estimated 1.1 million deaths annually from malaria, 2.1 million from HIV/AIDS, almost 600,000 from TB, 4.8 million from child mortality, 300,000 from maternal mortality and that s not counting malnutrition, water borne diseases like typhoid and cholera, or cervical, breast, prostrate and other cancers; heart, liver, kidney and lung disease."
Underlining the looming tragedy that the shocking figures demonstrate, Rotimi stated further:
"Unless they act without delay, the present generation of African leaders may well end up presiding over the beginning of the extinction of modern day Africa. The number of African lives lost annually to preventable, treatable and manageable health issues alone is equal to losing annually, the entire populations of Eritrea (4.4m people), Libya (5.8m people), Sierra Leone (5.5m people), or Togo (6.1 people). The coffins and burial business must be Africa s fastest growth industry. In the next 20 years Africa could lose more people than the 100 million it lost in all the 400 years of slavery and colonialism from which we are yet to fully recover. In 20 years an equivalent number to the population of Nigeria (130million) Africa s most populous country could die"


THE IMPACT IS LINEAR AND ESCALATING-AS THE U.S. STEALS MORE HEALTH WORKERS FROM AFRICA MORTALITY RATES WILL INCREASE

Physicians for Human Rights, Mobilizes health professionals to advance health, dignity, and justice for all, 7-13-06, “G8: What Would an Effective Health Worker Plan Look Like? Physicians for Human Rights Envisions a Plan to Alleviate Health Worker Shortage and Build African Health Systems,” http://physiciansforhumanrights.org/library/news-2006-07-13.html

Sub-Saharan Africa faces the greatest challenges. While it has 11 percent of the world's population and 24 percent of the global burden of disease, it has only 3 percent of the world's health workers. The World Health Organization says:
“There is a direct relationship between the ratio of health workers to population and survival of women during childbirth and children in early infancy. As the number of health workers declines, survival declines proportionately.”

This is going to get much worse. Why? Because the wealthy world is aging, therefore requiring more health attention. At the same time, wealthy nations are trying to reduce rapidly inflating health costs by holding down salaries, and increasing work loads, making the practices of nursing and medicine less attractive. Unless radical changes are put in place swiftly in the United States and other wealthy nations the gap will soon become catastrophic. Studies show that the U.S. will in 13 years face a shortage of 800,000 nurses and 200,000 doctors.

How are the United States and other wealthy nations filling that gap? By siphoning off doctors and nurses from the poor world. We are guilty of bolstering our healthcare systems by weakening those of poorer nations. Here is an example: due to healthcare worker shortages, 43 percent of Ghana’s hospitals and clinics are unable to provide child immunizations and 77 percent cannot provide 24-hour obstetric services for women in labor. So the children die of common diseases, like measles, and the mothers die in childbirth. In all of Ghana there are only 2,500 physicians. Meanwhile, in New York City, alone, there are 600 licensed Ghanaian physicians.



THE WINDOW IS CLOSING. WE MUST REVERSE THE AFRICA DISEASE CRISIS BEFORE IT IS TOO LATE
Vanguard (Nigeria), Nigerian Newspaper, 12-11-06, “Nigeria: Health Rights Activists Demand 15% Budgetary Allocation From African Leaders”
We also urge you to ensure that a significant percentage of the 15 per cent is dedicated to resolving Africa's health worker shortages, which is indisputably the most crucial component of every health sector. Without them to diagnose, prescribe or otherwise prevent, treat and care, no amount of medicines will resolve Africa's Public Health crisis.
The World Health Organisation report for 2006 states that although there is a universal health worker shortage, it underlines that Africa is the only continent where the total number of health worker shortages (817,992) exceeds the existing number of health care workers (590,198). Lack of financial resources for the health sector and policies of some developed countries means that 'Brain Drain' has exacerbated this problem. Consequently, Africa has more health workers working outside Africa than any other continent.
A failure to reverse these health worker shortages within the next 4 to 6 years means that all of Africa's 2010 Universal Access targets for prevention, treatment and care for HIV/AIDS, TB and malaria will definitely not be met. Even worse the three 2015 health related Millenium Development Goals-- based on scaling up reproductive health, children's health, and tackling the HIV/AIDS, TB, malaria and other diseases-- may be an impossibility. Without doubt, the future of Africa hinges on whether or not its public health crisis, (its overall human resource crisis) and in particular its health worker shortage is resolved.



Advantage Two: Poverty

EMIGRATION OF SKILLED WORKERS SLOWS GDP, CAUSES POVERTY, AND INEQUALITY—EMPIRICAL EVIDENCE
B. Lindsay Lowell, dir poli studies Georgetown U, and Allan Findlay, prof pop geography U Dundee, 12/01, International Labour Office Geneva, “Migration Of Highly Skilled Persons From Developing Countries: Impact And Policy Responses”, http://www.ilo.org/public/english/protection/migrant/download/imp/imp44.pdf, p. 6-7
However, subsequent work recast the assumptions of the first analysts and agreed that neoclassical models of economic development generated an expectation that brain drain has adverse effects on sending country development.7 In particular, high levels of skilled emigration slow economic (GDP) growth and, adversely affect those who remain. As a consequence poverty and inequality are likely to increase.
More recent economic theory, a.k.a. new or endogenous growth theory, also typically predicts that high skilled emigration reduces economic growth rates. Indeed, research finds that the average level of human capital in a society has positive effects on productivity and growth. One study of 111 countries 1960 to 1990 found that a one-year increase in the average education of a nation’s workforce increases the output per worker by between 5 and 15 per cent.8 Conversely, low average levels of education can slow economic growth, damage the earnings of low-skilled workers, and increase poverty.
Models of high skilled emigration support the expectation that reductions in the average level of human capital slow economic development; and the first order effect of emigration is unambiguously to reduce human capital. Empirical research finds that Eastern Europe’s economic growth was slowed by skilled emigration during the 1990s.9 The loss of human capital holds back potential economic growth. Further fallout would be upward wage pressures for remaining skilled workers and hence increased inequality.

POVERTY FACILITATES DANGEROUS RADICAL POLITICS AND THEIR ATROCITIES
Leif Ohlsson, researcher Dept Peace and Dev Research, U Göteborg, December 2k, SWEDISH INTERNATIONAL DEVELOPMENT COOPERATION AGENCY, “Livelihood Conflicts: Linking poverty and environment as causes of conflict” p. 4
Failures to meet such challenges create opportunities for extremely vile
political forces. In Kosovo, both the KLA and Slobodan Milosevic managed to
mobilise popular support at a rate that would otherwise have never been
possible, if poverty, unemployment, and environmental degradation had not
spread at such a rapid rate during the decades preceding the open conflict.



POVERTY CAUSES GENOCIDE – RWANDA PROVES
Leif Ohlsson, researcher Dept Peace and Dev Research, U Göteborg, December 2k, SWEDISH INTERNATIONAL DEVELOPMENT COOPERATION AGENCY, “Livelihood Conflicts: Linking poverty and environment as causes of conflict” p. 14-5
Here is the sequence of events identified by Gasana:
1) Following a severe famine in 1988–89, regime legitimacy was severely weakened by the dissatisfaction of the peasantry of southern Rwanda with the weak government response.
2) The regime failed to inform the nation of the seriousness of environmental scarcity in general, and of the famine in the south in particular. Lack of free debate on appropriate responses further alienated the southern élite.
3) The mounting political dissension distilled into organisations of dissatisfied peasantry.5
4) Rebel forces of exiled Rwandans in the Ugandan armed forces created the RPF, and seized the opportunity, created by the dissatisfaction of the peasantry and by the regime’s decreased legitimacy, to launch an invasion of Rwanda.
5) The tyrannical reaction of the regime to war further reduced its legitimacy and strengthened the opposition.
6) War in the north against the invading RPF forces caused the displacement of up to 1 million inhabitants, inducing additional resource demand and reducing supply, thus causing sharp grievances and strong anti-rebellion sentiment among the Rwandan people.
These were the conditions that created a situation ripe for ruthless exploitation by segments of the élite. Against the backdrop of extreme poverty and rapid pauperisation, due to loss of livelihoods caused by environmental scarcity over a long period of time, and acutely aggravated by a large part of the population being turned into internally displaced persons as a result of civil war, extremist forces were able to exploit the existing ethnic cleavages and historical animosities between groups in order to mobilise a very large part of the majority group of the population as perpetrators against the minority group in the first full-blown genocide since the Holocaust.6
Gasana is at great pains, however, to underline that at no time was this outcome determined by growing environmental scarcities. Scarcities, by way of loss of livelihoods, merely provided an opportunity for opportunistic political forces to mobilise people made vulnerable by poverty into atrocious acts. The lesson to remember here is that loss of livelihoods continues to create such opportunities in a growing part of the world.




POVERTY KILLS MORE THAN A NUCLEAR WAR
Mumia Abu-Jamal, former Reporter , 9/19/98, “A QUIET AND DEADLY VIOLENCE,” http://www.mumia.nl/TCCDMAJ/quietdv.htm]

The deadliest form of violence is poverty. -- Ghandi

It has often been observed that America is a truly violent nation, as shown by the thousands of cases of social and communal violence that occurs daily in the nation. Every year, some 20,000 people are killed by others, and additional 20,000 folks kill themselves. Add to this the nonlethal violence that Americans daily inflict on each other, and we begin to see the tracings of a nation immersed in a fever of violence. But, as remarkable, and harrowing as this level and degree of violence is, it is, by far, not the most violent feature of living in the midst of the American empire. We live, equally immersed, and to a deeper degree, in a nation that condones and ignores wide-ranging "structural" violence, of a kind that destroys human life with a breathtaking ruthlessness. Former Massachusetts prison official and writer, Dr. James Gilligan observes; "By `structural violence' I mean the increased rates of death and disability suffered by those who occupy the bottom rungs of society, as contrasted by those who are above them. Those excess deaths (or at least a demonstrably large proportion of them) are a function of the class structure; and that structure is itself a product of society's collective human choices, concerning how to distribute the collective wealth of the society. These are not acts of God. I am contrasting `structural' with `behavioral violence' by which I mean the non-natural deaths and injuries that are caused by specific behavioral actions of individuals against individuals, such as the deaths we attribute to homicide, suicide, soldiers in warfare, capital punishment, and so on." -- (Gilligan, J., MD, Violence: Reflections On a National Epidemic (New York: Vintage, 1996), 192.) This form of violence, not covered by any of the majoritarian, corporate, ruling-class protected media, is invisible to us and because of its invisibility, all the more insidious. How dangerous is it -- really? Gilligan notes: "[E]very fifteen years, on the average, as many people die because of relative poverty as would be killed in a nuclear war that caused 232 million deaths; and every single year, two to three times as many people die from poverty throughout the world as were killed by the Nazi genocide of the Jews over a six-year period. This is, in effect, the equivalent of an ongoing, unending, in fact accelerating, thermonuclear war, or genocide on the weak and poor every year of every decade, throughout the world." [Gilligan, p. 196] Worse still, in a thoroughly capitalist society, much of that violence became internalized, turned back on the Self, because, in a society based on the priority of wealth, those who own nothing are taught to loathe themselves, as if something is inherently wrong with themselves, instead of the social order that promotes this self-loathing. This intense self-hatred was often manifested in familial violence as when the husband beats the wife, the wife smacks the son, and the kids fight each other. This vicious, circular, and invisible violence, unacknowledged by the corporate media, uncriticized in substandard educational systems, and un-understood by the very folks who suffer in its grips, feeds on the spectacular and more common forms of violence that the system makes damn sure -- that we can recognize and must react to it. This fatal and systematic violence may be called The War on the Poor.


Contention Two: Solvency

SOLVING AFRICAN HEALTH CARE SHORTAGES IS KEY TO EFFECTIVELY COMBATING MOST DEADLY DISEASES
Kaisernetwork.org, Online Service committed health policy solutions, 3-15-07, Africa; Daily HIV/AIDS Report, “International Task Force Launched to Address Worldwide Shortfall in Health Workers, WHO Says”

A new international task force has been established to address the worldwide shortage of health care workers, the World Health Organization announced on Tuesday, Xinhua/People's Daily reports. According to WHO, the world is short 4.3 million health workers, with Africa short one million, and there is an "urgent need" to boost the number of health workers globally to tackle "immediate health crises." In addition, of the 57 countries with critical shortages in health workers, 36 are in sub-Saharan Africa, WHO says. HIV/AIDS, tuberculosis and malaria, as well as maternal and child mortality, "will not be significantly reduced unless the crisis in health workers is tackled," according to Lord Nigel Crisp, former chief executive of the United Kingdom's National Health Service. Crisp -- along with Bience Gawanas, the African Union commissioner for social affairs -- will chair the task force (Xinhua/People's Daily, 3/14). The 11-member task force aims to promote increased investment in educating and training health workers in developing countries and to boost international support for practical strategies to address the shortage (U.N. News Service, 3/13). The task force also will focus on the need and scope for financial and technical support worldwide; the links between training institutions and universities in developed and developing countries; and innovative use of technology for distance education. It also will collaborate with other programs that deal with issues such as access to HIV/AIDS prevention, treatment and care; health worker migration; and health financing (WHO release, 3/13). Two health ministers from African countries -- Stephen Mallinga of Uganda and Marjorie Ngaunje of Malawi -- also will serve on the task force, as will senior health policy makers from the public and private sectors worldwide. The task force, which has been established under the auspices of the Global Health Workforce Alliance, met for the first time on Tuesday in Geneva (Xinhua/People's Daily, 3/13). The task force is scheduled to present its initial recommendations to GWHA in the fall of 2007 (WHO release, 3/13).

1AC

INCREASED FUNDING CAN DOUBLE HEALTH CARE WORKERS IN AFRICA AND SOLVE THE SPREAD OF DEVASTATING DISEASE
Physicians for Human Rights, Mobilizes health professionals to advance health, dignity, and justice for all, 1-01-05, “Cost Estimates: Doubling the Health Workforce Doubling the Health Workforce in Sub-Saharan Africa by 2010”
Urgent action is needed to overcome the crisis of health workers. None of the global health goals, especially tackling HIV/AIDS, will make headway without massive mobilization of an adequately motivated, skilled, and supported workforce. For sub-Saharan Africa, it is within our reach to double the health workforce by 2010i, including by expanding training capacity, deploying trained and supervised community-based workers, extending coverage in under-served communities, and strengthening management, planning, safety, and support systems. An immediate infusion of resources could jump-start the workforce to reverse the spiral of avoidable death, sickness, and human suffering. The G8 Summit presents a key opportunity for the United States to commit to this goal, and leverage financial support from other nations. This investment in health workforce strengthening is a necessary complement to ensure the success and sustainability of historic U.S. investments to fight AIDS. Health workforce strengthening can be a cornerstone of an expanded U.S. initiative for health in Africa.
An initial investment of an estimated $2.0 billion in 2006, rising to an estimated $7.7 billion annually by 2010, is needed from African governments and the collective donor community to double sub-Saharan Africa's health workforce while increasing its effectiveness, thus making significant progress towards developing the workforces required for countries in sub-Saharan Africa to achieve national and global health goals.
Variability of country circumstances, strategies, and capacity to absorb and effectively use resources will determine the actual investment size, pace, and pattern in any given country. At the country level, strategies and their costs should be based on rationally gathered data and intelligence at the national and sub-national levels. Donor support for health workforces should occur through funding these national strategies.
Investments in health workforces will need to be accompanied by donor and country-level policies that increase the size, skill, motivation, and support for the health workforce, especially in the rapid launch of and the development of proper support and supervision for community-level health worker initiatives. The majority of the new funds required will have to come from the donor community. Further, it is critical that the fiscal space for these investments be available, which will require reforms of macroeconomic policies and their implementation, as well as more predictable donor funding.


INCENTIVES EMPIRICALLY SOLVE SHORTAGES- SEVERAL COUNTRIES PROVE
Physicians for Human’s Rights, Mobilizes health professionals to advance health, dignity, and justice for all, 6-04, “An Action Plan to Prevent Brain Drain: Building Equitable Healthy Systems in Africa, http://physiciansforhumansrights.org/library/documents/reports/report-2004-july.pdf

African countries, with assistance if necessary from the United States and other donors, should provide extra salaries and benefits to health workers who take posts in rural or other underserved areas. Health professionals working in especially remote or otherwise unpopular facilities should be eligible for extra incentives. Just as increased remuneration generally is a key strategy to recruiting and retaining health professionals in Africa and other low-income countries, additional increases in salary and benefits are likely to help attract health professionals to rural areas, or encourage those already posted in rural and other underserved areas to remain. These incentives may take many forms, and need not be monetary, or exclusively monetary. For example, they might include extra vacation or study time, employment assistance for health workers’ spouses, and assistance with accommodations and the education of health workers’ children.588

Several African countries, recognizing the potential benefits of these incentives, have introduced increased pay for rural health workers. Mauritania, as part of a program to supplement salaries of health and education special incentives for civil servants, is providing higher bonuses for workers in remote rural areas.589 In early 2004, the Director-General of the Ghana Health Service announced that Ghana would soon introduce a package of benefits, a Deprived Area Allowance Scheme package, to health workers who accept posts in any of 55 designated deprived areas. District assemblies are to manage the incentives.590

South Africa also provides special allowances to rural health professionals. South Africa’s health budget allocates a total of 500 million rand (about $70-85 million) for two types of allowances, rural health allowances and scarce skill allowances, for health workers in 2003/2004. The funding is set to increase to 750 million and in 2004/2005 and1 billion rand in 2005/2006. Depending on how the rural area in which the health professionals work has been designated, professional nurses will receive an additional 8-12% of salary; psychologists, pharmacists, and several other classes of health professionals will receive an additional 12-17% of salary, and; doctors and dentists will receive an additional 18-22% of salary.592

When designing incentives for health workers in rural areas, as for other salary and benefits packages, it is critical that governments make the incentives fair across different categories of health workers. That nurses receive only about half the percentage of their salaries as a rural allowances as physicians raises some concern given the importance of fair salary structures and Ghana’s experiences with the ADHA.

Governments should also consider the possibility of special incentives for particular rural health facilities that have extra difficultly attracting health professionals. The facility might be particularly remote or have a reputation as a difficult place to work. For example, the head nurse at the Mount Ayliff Hospital, in Eastern Cape reported in
April that the very high workload at the facility discourages people from applying, so no one responds to job postings for the hospital. She thought that greater incentives for health facilities that are especially short-staffed or otherwise in need of additional incentives to attract staff could help hospitals such as hers.59


RURAL COMMUNITY HEALTH WORKERS CAN REVIVE MEDICAL CARE AT A GRASS ROOTS LEVEL AND INCREASE PREVENTIVE TREATMENT
Physicians for Human Rights, Mobilizes health professionals to advance health, dignity, and justice for all, 7-13-06, “G8: What Would an Effective Health Worker Plan Look Like? Physicians for Human Rights Envisions a Plan to Alleviate Health Worker Shortage and Build African Health Systems,” http://physiciansforhumanrights.org/library/news-2006-07-13.html

Getting Health Workers to Rural Areas
Special incentives could be provided for health workers to serve in rural areas, which might include housing and transportation loans and grants, and possibly other allowances. Special attention would be given to developing infrastructure in these facilities, including assuring that they have electricity and clean water. Cell phones would be given to staff both to reduce their social isolation, increase their contact with supervisors and other health workers both for medical advice and to ease referrals, and to improve their security.
Community Health Workers
Investments would be made at all levels of the health workforce. Special attention would be given to expanding access to health services, and thus to the needs of rural and other underserved populations. Along with above-mentioned strategies (e.g., rural incentives, recruitment from rural areas), community-level health workers would be supported so that every community has or can easily access a health worker who can be their entree into the health system. In some cases, these community-level health workers would be paraprofessionals with up to two years of training. Elsewhere, they would be community health workers with lesser levels of training -- perhaps several months -- but fully competent in the tasks that they perform.
The community-level health workers would be trained, paid, given career paths and ongoing training, and closely linked to their supervisors to ensure that their needs were met and that they provided quality care. Many of these health workers would be (and are) women and people living with HIV/AIDS. The work would afford them a job and respect in the community. While some community health workers would engage in a relatively narrow set of activities, such as supporting home-based care, many community health workers, as well as community-based paraprofessionals who have more training, would engage in a range of basic preventative and curative activities. In addition, they would be trained to recognize and fight AIDS stigma, whether it exists in their own ranks or among the communities they serve.
These community-level health workers would be an interface between community and the health system, increasing trust in the health system and increasing access. They would be engaged in key health issues in the community that go beyond the delivery of health services, including
teaching people about hygiene and sanitation, helping ensure that they have access to clean water
(being community advocates when they do not), and helping prevent, detect and address malnutrition. They would be engaged in HIV prevention education, treatment literacy, and a host of other activities. For patients with health conditions beyond their scope of service, the community-level health workers would refer patients to the next level of care. [Continues on next page]
Different communities and counties would use these community-level health workers in different ways. One solid model is to initially train community-level workers in a narrow set of activities, and once they become well-versed and comfortable in these activities, to provide further training; in this way gradually increasing the scope of their competency. In another successful model, community members with at least eight years of formal education are trained for two years, with classroom instruction in the morning -- which often includes group discussion and role-playing -- and field experience working alongside qualified rural health workers in the afternoon.
These community-level health workers can lead to rapid, dramatic improvements in health outcomes, as in Ghana, where community-level paraprofessionals known as Community Health Officers were deployed. In the Birim North district, the community health program which began there in 1999 has almost completely eradicated guinea worm, tripled childhood immunization coverage, improved tuberculosis treatment default rates from 73% in 2001 to 0% at the end of 2004, and significantly reduced maternal and child mortality rates.



AFRICAN HEALTH CARE SYSTEMS ARE NOT BEYOND SAVING. DECENT SALARIES WILL RETAIN HEALTH CARE PROFESSIONALS
Hetherick Ntaba, Health Minister of Malawi, 7-08-05, “Africa doctors, AIDS,” International Herald Tribune, page 11

We are not alone. Across Africa, a slender 1.3 percent of the world's health care workers struggle to care for people suffering 25 percent of the world's disease. Meanwhile, Western countries recruit them every year by the thousands. In one year alone, Britain recruited 3,000 nurses from African countries. Indeed, some African countries' health delivery systems are in danger of collapsing because of this human resource crisis. It is like the biblical saying, "To those that have more, more is being given. For those with less, even that is being taken away."

While Malawi may never pay as much as Britain, many of our doctors and nurses would like to stay at home and join the fight against AIDS and other diseases if only they could earn a living wage. But this would take money - funds that are not available. Last week, the U.S.-based group Physicians for Human Rights released an estimate, the first of its kind, revealing how much it would cost to ease Africa's health care worker shortage. Money is needed to increase salaries, improve training for workers and to help build health systems that are crumbling.

FOREIGN AID IS NECESSARY TO KICK START AFRICAN SELF-HELP
Jeffrey D. Sachs et al, dir The Earth Inst Columbia U, 2004, UN Millennium Project, “Ending Africa’s Poverty Trap” p. 139
In highlighting these points, we are certainly not arguing for any geographical determinism. Indeed, the whole point of the paper is the opposite: Africa’s structural impediments can be overcome, if they are compensated by an intensive investment program that directly confronts the continent’s high transport costs, low agricultural productivity, heavy disease burden, colonial legacy of poor educational attainment, and the like. We are arguing, however, that Africa’s structural problems help to account for its current trap. Each of the factors mentioned has made it much harder for Africa to lift itself up by its bootstraps. Rural and inland Africa, plagued by disease, huge transport costs, and low agricultural yields, was unable to generate enough of an economic surplus above survival levels that could be invested sufficiently to overcome these conditions. Poor governance no doubt complicated the task—many natural resource rents were squandered—but the poor governance itself was as much symptom as cause.23 To break out of the poverty trap, Africa needs help, and it has not yet gotten it in the form and to the extent that is necessary.